Basic Information
| Provider Information | |||||||||
| NPI: | 1679588016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAFRESHI | ||||||||
| FirstName: | MAHNAZ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ACUPUNCTURIEST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 PARREMO | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495818542 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 502 HOLT AVENUE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096205699 | ||||||||
| FaxNumber: | 9096205799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC9010 | CA | Y | Other Service Providers | Acupuncturist |
ID Information
| ID | Type | State | Issuer | Description | AC0090100 | 01 | CA | MEDICAL | OTHER |